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Role of Yoga in the Management of Premature Ejaculation

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Premature ejaculation (PE) is a common male sexual problem. Various non-pharmacological and pharmacological treatment options are available currently. The importance of yoga in the management of various sexual dysfunctions is increasingly recognized. In this review, we are analyzing the role of yoga in the management of PE. This paper explores the mechanism of yoga practices in the management of PE and the recommended yoga practice for PE. It also discusses the scientific evidence of yoga practices, such as yoga postures (yogasana), breathing practices (pranayama), lock (bandha), gestures (mudra), relaxation, Aum chanting, yoga nidra and meditation with particular reference the management of PE.
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INTRODUCTION
Premature ejaculation (PE) is one of the most com-
mon male sexual dysfunction affecting around 30%
of a male population [1]. PE can adversely aff ect the
quality of life of the patients and his partner [1]. Still,
it is one of the common conditions which are under-
reported and under treated [2]. Three domains which
define PE include short ejaculatory latency, perceived
lack of control on ejaculation and negative personal
consequences and interpersonal issues. Length of time
between penetration and ejaculation is one of the ma-
jor components of diagnosis of PE which can be mea-
sured using a stopwatch or estimated. Studies show
that 80% to 90% of men with a lifelong PE ejaculate
within 1 minute [3]. Inability to control ejaculation and
thereby prolonging sexual intercourse is also important
for the diagnosis of PE. PE is associated with increased
personal distress and interpersonal dif ficulty adversely
af fecting self-esteem, self-confidence, quality of life of
the person and relationship with the partner [2].
International Society for Sexual Medicine (ISSM) de-
fines lifelong PE as “a male sexual dysfunction charac-
terized by ejaculation which is always or nearly always
occurs prior to or within about one minute of vaginal
penetration, or, a clinically significant and bother-
some reduction in latency time and; inability to delay
ejaculation on all or nearly all vaginal penetrations;
and, negative personal consequences, such as distress,
bother, frustration, and/or the avoidance of sexual in-
Received: Apr 25, 2019 Revised: Jul 16, 2019 Accepted: Aug 1, 2019 Published online Sep 3, 2019
Correspondence to: Raveendran Arkiath Veettil https://orcid.org/0000-0003-3051-7505
Department of Internal Medicine, Government Medical College, Kozhikode, Kerala 673008, India.
Tel: +96-892065598, Fax: +00968-26884918, E-mail: raveendranav@yahoo.co.in
Copyright © 2019 Korean Society for Sexual Medicine and Andrology
Role of Yoga in the Management of Premature
Ejaculation
Anjali Mangesh Joshi1, Raveendran Arkiath Veettil2,3 , Sanjay Deshpande4
1Consultant Yoga Therapist; Nagpur, 2Department of Internal Medicine, Government Medical College, Kozhikode, India, 3Department of
Internal Medicine, Badr Al Samaa, Barka, Sultanate of Oman, 4Consultant Sexologist; Sex Education and Counselling Clinic, Nagpur, India
Premature ejaculation (PE) is a common male sexual problem. Various non-pharmacological and pharmacological treatment
options are available currently. The importance of yoga in the management of various sexual dysfunctions is increasingly
recognized. In this review, we are analyzing the role of yoga in the management of PE. This paper explores the mechanism of
yoga practices in the management of PE and the recommended yoga practice for PE. It also discusses the scientific evidence
of yoga practices, such as yoga postures (yogasana), breathing practices (pranayama), lock (bandha), gestures (mudra), relax-
ation, Aum chanting, yoga nidra and meditation with particular reference the management of PE.
Keywords: Meditation; Premature ejaculation; Yoga; Yogasana
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)
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Review Article
pISSN: 2287-4208 / eISSN: 2287-4690
World J Mens Health Published online Sep 3, 2019
https://doi.org/10.5534/wjmh.190062
Male sexual health and dysfunction
https://doi.org/10.5534/wjmh.190062
2www.wjmh.org
timacy” [2]. ISSM defines acquired PE as “reduction in
latency time, often to about 3 minutes or less which is
clinically significant and bothersome” [2].
Non-pharmacological treatment options like naturopa-
thy, yoga, tantra, tao, mindfulness, and acupuncture in
sex therapy have been implicated f or enhanced sexual
fulf illment, pleasure and improved sexual f unction.
These techniques are not new and have been in practice
amongst sexologists since the 1960s [4]. Scientific evalu-
ation of some of the complementary and alternative
medicine approaches in the past few decades has proven
their efficacy. With global recognition and increasing
popularity in the health care sector, yoga shows highest
growth in natural therapy, according to a survey from
the National Institutes of Health [5]. Although yoga is
being practiced since ancient time, yoga as therapy is
still a relatively new and emerging trend in the health-
care field. Extensive research in yoga has facilitated
its practical application and it is now being recognized
worldwide as a clinically viable treatment option.
Originated in India more than 5,000 years ago, yoga
is a science of right living and is intended to be incor-
porated into daily life. Traditionally, a mind-body prac-
tice with the ultimate goal of spiritual enlightenment,
yoga is a science of health management rather than a
therapy for treating disease.
PATHOPHYSIOLOGY OF PREMATURE
EJACULATION
Psychological and neurological factors are important
in the control of ejaculation. In genetically predisposed
individuals, there is impairment in the inhibition se-
rotonergic pathway controlling ejaculation. When this
inhibitory control is impaired, it results in PE. This is
modulated by 5HT2c, 5HT1a, 5HT1b receptors and syn-
aptic serotonin transporters [6,7]. Other conditions like
chronic prostatitis and hyperthyroidism predispose to
PE [8,9].
ROLE OF YOGA IN PREMATURE
EJACULATION
1. Concept of sex in yoga relevant to
premature ejaculation
1) Tantra yoga
Although there are various forms of yoga, tantra
yoga is said to be very much linked with sex. Tantra
yoga used to be a preferred practice in ancient India
for enhanced sexual pleasure. Lousada and Angel [10]
proposed potential therapeutic applications of ‘‘tant-
ric’’ practices and similar techniques. They provide a
holistic and accessible approach in the management of
sexual dysfunction, including intimacy issues, psycho-
logical blocks around sexuality, erectile dysfunctions,
and PE.
2) Kundalini yoga
Kundalini energy is believed to increase sexual plea-
sure and extend the longevity of sex by facilitating
male orgasms without ejaculation [11]. Kundalini yoga
is believed to help in attaining a meaningful relation
and satisfying sexual life [12].
3) Bindu Samrakshana (conservation of semen)
There is a unique concept of Bindu Samrakshana
(conservation of semen) in the classical text of Hatha
Yoga Pradeepika [13]. This can be useful in under-
standing the concept of PE. It is also suggested that yo-
gic practices for conserving semen may have potential
in the treatment of PE [14].
2. The proposed mechanism for improved
sexual function with yoga practice
The following are the mechanisms by which yoga is
helpful in improving ejaculatory time in people with
PE (Fig. 1).
1) Neuro-psycho-physiological mechanism
Yoga practices are believed to have a neuro-psycho-
physiological mechanism of action. Yoga therapies
have found to improve reproductive functions both in
men and women by improving the overall integration
of the physiological systems [15].
2) Hormonal regulation
Yoga practices improve sexual desire and overall re-
productive health by integrating neuroendocrine axes,
improving hormonal secretion, improving age-related
decline in testosterone levels, reproductive behaviour,
mood and also by reducing anxiety and stress [16].
3) Autonomic function improvement:
parasympathetic stimulation
Autonomic function improvement as a result of yoga
Anjali Mangesh Joshi, et al: Yoga in Premature Ejaculation
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practices with suppressed sympathetic activity and
predominant parasympathetic activity is thought to
benefit reproductive health [16,17]. Contraction of epi-
didymis, ejaculatory ducts, and seminal vesicles is be-
lieved to be because of sympathetic nerves stimulation
causing ejaculation of semen. Parasympathetic stimu-
lation through yoga practices is beneficial in enhanc-
ing ejaculatory control [18].
4) Increase in whole blood serotonin
5-hydroxytryptamine levels
Breath awareness, abdominal breathing and focused
attention are important components of yoga practices,
such as pranayama and meditation. It is observed that
the focused attention on the breathing movements in
the lower abdomen was correlated with a signif icant
increase in whole blood serotonin 5-hydroxytrypta-
mine (5-HT) levels [19]. A suggested hypothesis f or the
pathophysiology of PE is the involvement of 5-HT in
ejaculatory control. Elevated concentrations of 5-HT
are believed to be involved with ejaculatory control [20].
5) Strengthening pelvic muscles
Yoga practice improves stamina, strength, flexibility,
muscle tone, endurance and builds core stability. Yoga
postures develop control of pelvic and perineal muscles
resulting in better contraction [14].
6) Enhanced awareness
Improved cardiopulmonary eff iciency, deeper breath-
ing, awareness and mindf ulness result in a better
sensual experience. Improvements in intra-vaginal
ejaculation latency time (IELT) with yoga practice may
be because of the emphasis on bodily awareness that
could potentially increase awareness of the impending
ejaculation, allowing more effective withdrawal and
pause m et hods [21 ].
7) Management of associated risk factors of
premature ejaculation
Most types of sexual dysfunction can be corrected
by treating the underlying physical or psychological
problems. The integrated mind-body practice of yoga
improves physical health, mental health, induces re-
laxation and promotes a sense of overall wellbeing. All
these effects help to manage the associated risk factors
of sexual dysf unction and ref lect on improvement of
sexual functions. If mind and body are not in har-
mony, it is difficult to experience fulfilling sexual life.
Physical health, mental health, sense of wellbeing and
Fig. 1. Proposed mechanisms of benefi-
cial effect of yoga in premature ejacula-
tion. 5-HT: 5-hydroxytryptamine.
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sexual health are interrelated. Sexual dysfunction in
men and women have been f ound to be associated with
risk factors like diabetes, heart disease and chronic
illness. Depression, anxiety, medications used to treat
them and substance abuse also contribute significantly
to sexual dysfunction [22]. Psychological comorbidities
such as depression, anxiety, excessive stress are associ-
ated with PE [23].
An integrated approach of yoga therapy is found
to be effective in the management of type 2 diabetes,
obesity, hypertension and lipid prof ile, cardio-metabolic
risk factors, anxiety and depression, and substance use
disorders [24-28].
RECOMMENDED YOGA PRACTICES
FOR PREMATURE EJACULATION
Yoga practice involves cleansing processes (kriya),
postures (asana), controlled breathing (pranayama),
meditation, relaxation, chanting mantras, yogic diet,
ethical code of conduct, philosophy and spirituality.
These contribute in improving sexual function directly
or indirectly by improving overall health, vitality and
wellbeing. There are many different styles of yoga,
having various components. Many of these practices
are saf e; however, some can be strenuous, may not be
appropriate for everyone and need to be modified to
suit individual requirements. The following are a few
selected yoga practices with their specific ef f ects on PE
(Table 1).
1. Yoga postures
It emphasizes the relationship between body, mind,
and awareness. It focuses on the synchronization of
breathing and movement. Inverted postures improve
blood flow to reproductive organs and pelvic region.
Backward bending postures are stimulating, anti-de-
pressive, improve vitality and elevate mood [29]. Wool-
ery et al [29] suggested the potential benefits of using
yoga asana that open and lift the chest, particularly
backbends, as well as standing poses and inversions to
improve mood. Forward bending poses have a calming
and soothing ef fect. Seated poses improve flexibility
of the hips, knees and ankles. Twisting and stretching
improves suppleness of the spine.
Hectic and stressful lif estyle leads to tightening up
of the pelvic region. It is suggested that stretching
these muscles will improve the range of movement in
this area and facilitate a more relaxed state of mind
so that sexual performance will improve [12]. It is ob-
served that poorly relaxed pelvic and perineal muscles
can cause PE. Yoga practices promote a relaxed and
focused mind and relaxed perineal and pelvic muscula-
ture [30].
Eff ect of a few yoga poses and mudra such as supine
yoga poses Bhujangasan, Shalabhasan, Naukasan, in-
verted poses Viparit Karni, Sarvangasan, seated poses
Yoga Mudra, Supta Vajrasan, Pashchimottanasan,
Ashwini Mudra, standing poses Hastapadasan and
Trikonasan was evaluated in a study regarding the po-
tential benef its f or PE [31].
Patil et al [31] recommended that, seated yoga pos-
tures such as Yoga Mudra, Paschimotasan improve the
tone and f lexibility of the perineal and pelvic muscles
more as compared to other postures. It was also sug-
gested that seated yoga postures relax these muscles
more allowing an increased ejaculatory threshold.
Inverted poses such as Viparita Karani promote
return of venous blood pooled in the big veins and
various venous plexuses in the region of pelvis and
perineum which otherwise have to drain against grav-
ity. Further, it enhances the flow of fresh blood to the
pelvic viscera [32].
2. Kriya (cleansing process)
Kapalbhati, a breathing practice involving forced
exhalation (through the nose) and passive, automatic
inhalation (through the nose) is one of the kriya
(cleansing process). Kapalbhati has been included as a
part of the yoga protocol to improve sexual functions
in males [18,33]. In tantric breathing technique, a varia-
tion of Kapalbhati is recommended to prolong sexual
intercourse. This involves Kapalbhati practice through
the mouth as the man approaches orgasm. This rapid
puffing out of the air through the mouth is believed to
change the blood chemistry and prolong ejaculation [34].
3. Pranayama (regulated breathing)
Pranayama is controlled or regulated yogic breathing
practice. It is very eff ective in reducing heart rate and
cardiovascular risks, and in improving cardiovascular
health [35]. Diaphragmatic breathing effectively reduc-
es the anxiety level through the reduced sympathetic
activity and enhanced vagal activity [36]. Immediately
after 5 minutes slow pace Bhastrika pranayama with
respiratory rate 6 times/min, a signif icant decrease in
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Table 1. Yoga practices for premature ejaculation
Variable Yoga practice detail Effect/Mechanism
Surya Namaskar Sun Salutation involves a dynamic sequence of 12 poses
involving forward and backward bending.
Contracting and expanding the pelvic muscles.
Yogasana (yoga postures)
Standing poses Garudasan (eagle pose)
Trikonasan (triangle pose)
Uttanasana (standing forward bend)
Vatayanasan (flying horse pose)
Strengthen the pelvic area and tones the reproductive
organs.
Improved circulation to the pelvic region.
Develops the ability to retain seminal fluid and prevents
premature ejaculation.
Seated poses BaddhaKonasan (seated heel-to-heel pose)
Yoga mudra (forward bend)
Ardha Matsyendrasan (seated spinal twist)
Pashchimottanasan (seated forward bend)
Janu Shirsasan (seated head-to-knee posture)
Upavistha Konasan (wide-legged forward bend)
Maha Mudra (great psychic attitude)
Vajrasana (thunderbolt pose)
Marjari Asana (cat stretch pose)
Ushtrasan (camel pose)
Shashankasan (hare pose)
Kapotasan (pigeon pose)
Improved circulation to the pelvic area.
Improve the tone & flexibility of perineal and pelvic
muscles [28].
Seated poses more effective in PE [28].
Improve the health of the reproductive and urinary
system.
Facilitate higher arousal.
Result in better and controlled orgasms.
Prone poses Shashank Bhujangasan (striking cobra pose)
Bhujangasan (cobra pose)
Dhanurasan (bow pose)
Utthanpristhasan (lizard pose)
Strengthen the pelvic region.
Tone the reproductive organs stimulates the sexual energy
centers.
Facilitate stronger orgasm.
Useful in arousal difficulties and PE.
Supine poses Supta Vajrasan (sleeping thunderbolt pose)
Setubandha Sarvangasan (bridge pose)
Supta Baddha Konasan (reclining heel-to-heel pose)
Matsyasan (fish pose)
Improve the tone & flexibility of perineal and pelvic
muscles [28].
Strengthen the pelvic area and tone the reproductive
organs.
Inversions Vipareet Karani (inverted pose)
Sarvangasan (shoulder stand)
Halasan (plough pose)
Adhomukha Shvanasan (downward dog pose)
Increase circulation to the pelvic organs.
Prevent premature ejaculation.
Improve the tone & flexibility of perineal & pelvic muscles
[28].
Promote the return of venous blood pooled in the big
veins and various venous plexuses in the region of pelvis
and perineum.
Enhance the flow of fresh blood to the pelvic viscera [29]
Relaxation Shavasan (corpse pose) Induces deep relaxation.
Enhances focus, and energy and awareness.
Kriya (cleansing
process)
A variation of Kapalbhati practice through the mouth, as
the man approaches orgasm is recommended for PE.
Rapid puffing out of the air through the mouth prolong
ejaculation [31].
The effects have been compared with Viagra.
Diaphragmatic
breathing
Rhythmic, slow, deep inhalation and extended
exhalation
Reduces the anxiety level through reduced sympathetic
activity and enhanced vagal activity [33].
Pranayama Slow Bhastrika pranayama breathing (respiratory rate
6 times/min)
Systolic and diastolic blood pressure decrease significantly
[34].
Pranayama
(regulated
breathing)
Anulom-vilom (alternate nostril breathing), Chandranadi
(left nostril breathing), Sitkari (cooling breaths),
Bhramari (humming bee breath)
Improve cerebral blood flow and oxygenation.
Improve sympathovagal outflow [32].
Control autonomic nervous system and regularize rate and
pattern of breathing [32,35].
Om chanting Based on the analysis of EEG signal on the basis of fractal
dimension, recommended chanting Om for fifty times
or more to relax the mind [42].
Results in the stabilization of brain, removal of negative
thoughts, increase of energy, mind and body relaxation
within minutes of practice [38].
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systolic and diastolic blood pressure was observed in a
st ud y [37 ].
4. Pranayama: mechanism of action
Neurophysiological effects of pranayama practice
have been studied in extensive scientific research.
Slow breathing technique in pranayama causes com-
prehensive changes in body physiology by controlling
the autonomic nervous system and regularizes rate
and pattern of breathing [35,38]. It also regulates heart
rate and heart rate variability [35]. Slow pranayama,
such as Anulom-vilom (alternate nostril breathing),
Chandranadi (left nostril breathing), Sitkari (cooling
breaths), and Bhramari (humming bee breath) improve
cerebral blood f low and oxygenation. As a result, neu-
ronal activities of the brain centers improve sympatho-
vagal outflow [35].
5. Bandha (lock)
Bandha means hold, tighten or lock. Moola bandha
(Root lock) involves contraction of the perineum, the
area between the anus and genital organs. The muscle
which mainly contracts in the practice of Moola band-
ha is puboperinealis muscle. Moola bandha works as an
exercise to the muscles of the pelvic region, especially
levatorani and anal sphincters and makes the pelvic
and perineal muscles stronger [32].
Moola bandha stretches the pelvic floor muscles,
strengthens them, improves circulation, improves the
efficiency of pelvic and abdominal organs and enhanc-
es awareness. Moola bandha is being used as a practice
to enhance awareness of genital arousal sensations in
many sex therapy sessions at dif ferent centers [16].
6. Mudra
1) Ashwini mudra (horse gesture)
Performed by contracting the sphincter muscles of
the anus and then relaxing them, Ashwini mudra
may be integrated with yoga postures and can also be
practiced anytime, anywhere in seated or lying down
position. It is believed to awaken Kundalini Shakti and
useful for PE [39].
2) Vajroli mudra (thunderbolt/spontaneous
psychic attitude)
This mudra is practiced by drawing the urethra up-
ward, the muscle action being similar to holding back
an intense urge to urinate. Vajroli mudra involves
the f unctioning of muscles similar to Kegel exercises,
which is suggested to gain voluntary control over Pu-
bococcygeus muscle and can provide men with stronger
Table 1. Continued
Variable Yoga practice detail Effect/Mechanism
Bandha (lock) Moola bandha (root lock): Contraction of the perineum,
the area between the anus and genital organs,
puboperinealis muscle
Enhances awareness of genital arousal sensations [15].
Moola bandha works as an exercise to the muscles of the
pelvic region especially levator ani and anal sphincters
and makes the pelvic and perineal muscles stronger [29].
Meditation Internalized awareness Beneficial effects on brain EEG, immune response, pain
control, anxiety, depression with potential in the
management of sexual dysfunction [42].
Mindfulness Present moment awareness and paying attention in a
nonjudgmental way.
Attention regulation, body awareness, emotion regulation
and changes in perspective on the self [43].
Mudra (gesture) Ashwini mudra (horse gesture): Contracting the
sphincter muscles of the anus and then relaxing them
Improves the tone and flexibility of perineal and pelvic
muscles [28].
Awakens the Kundalini Shakti and useful for PE [36].
Vajroli mudra: Drawing the urethra upward. Strengthens the pelvic floor, resulting in stronger erections
and better ejaculatory control [27].
Regulates the entire sexual system.
Regulates testosterone level.
Control over premature ejaculation [37].
Yoga nidra (yogic
sleep)
Yogic relaxation technique Reduces the stress and result in physical, mental and
emotional relaxation [40,41]. Enhances self-awareness
and self-efficacy [41].
PE: premature ejaculation, EEG: electroencephalogram.
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erections and better ejaculatory control [30]. It also
strengthens the pelvic floor, which may help men to
attain orgasm without ejaculation, and thus a man can
achieve multiple “climaxes” during the sexual act [30].
According to yoga physiology, Va jroli mudra regulates
the entire sexual system, regulates testosterone level
and sperm production. It gives control over PE and
helps correct impotence [40].
7. Aum/Om chanting
Chanting aum mantra results in stabilization of
brain, removal of negative thoughts, an increase of
energy, mind and body relaxation within minutes of
practice [41]. Harne [42] observed encouraging results
of Om chanting f rom analysis of electroencephalogram
(EEG) signal on the basis of fractal dimension and rec-
ommended chanting Om 50 times or more to relax the
mind.
8. Yoga nidra (yogic sleep)
Yoga nidra is a very powerful, comprehensive, pro-
found and deepest possible relaxation while being f ully
conscious and aware. Yoga nidra has a great potential
to reduce the stress and result in physical, mental
and emotional relaxation [43,44]. It also enhances self-
awareness and self-eff icacy [44].
9. Meditation (dhyan)
Meditation and mindf ulness have become stan-
dardised therapeutic interventions [45]. It is suggested
to have beneficial ef f ects on brain EEGs, the immune
response, pain control, anxiety, depression with poten-
tial in the management of sexual dysfunction.
10. Mindfulness
Mindf ulness, a practice of relaxed wakef ulness, is
based on the ancient eastern tradition of meditation. It
involves present moment awareness and paying atten-
tion in a non-judgmental way. The exact mechanisms
by which mindfulness relates to sexual well-being are
poorly understood. However, attention regulation, body
awareness, emotion regulation and changes in perspec-
tive on the self are the suggested mechanisms [46].
Butterf ield et al [27] suggested that sex therapists may
play an important role in supporting their patients to
adopt yoga-based lif estyle to cope with stress, anxiety,
depression and to restore emotional health.
YOGA FOR PREMATURE
EJACULATIONEVIDENCE FROM
CLINICAL PRACTICE
There is scarcity of high level evidence data on the
role of yoga in PE in the available literature. Effect
of yoga on PE is evaluated in a few studies and Level
of Evidence 2b Grade C has been found in yoga for
PE [21]. Dhikav et al [18] successfully treated PE with
yoga and proposed it as a potential treatment for PE.
He compared the eff icacy of 12-week yoga intervention
with fluoxetine, a known treatment option for PE and
observed significant improvement in PE in the yoga
group. In another study, Dhikav et al [33] reported
improved Male Sexual Quotient including desire, in-
tercourse satisfaction, performance, conf idence, part-
ner synchronization, erection, ejaculatory control, and
orgasm. Based on this work, many “bedroom yoga” or
“kama yoga” classes have started in few countries. It is
claimed that yoga has become “new Viagra” or natural
male sexual stimulant [47].
Eff icacy of yoga and naturopathy intervention was
investigated in a study [14]. No improvement in the
total score of the premature ejaculation severity index
was identif ied. However, encouraging results related to
IELT and control over ejaculation were observed.
Ejaculatory control can be affected by many f actors
including performance anxiety with other conditions.
Ciocca et al [48] recommended a holistic approach con-
sidering the biological, psychological, and relational
aspects of the treatment of PE. A relaxed stress-free
mind, improved flexibility of pelvic and perineal mus-
cles is the key features of yoga helpful f or the treat-
ment f o r PE.
DURATION OF YOGA PRACTICE FOR
PREMATURE EJACULATION
1. Duration of daily practice
The proposed duration of yoga practice f or PE is one
hour daily [14,18,31]. It is suggested that yoga poses are
to be practiced for approximately 30 to 40 minutes [49]
or 20 to 30 minutes [31], followed by breathing practices
or pranayama for approximately 10 minutes [31,49]. It
is also suggested that mudra including perineal and
pubococcygeal exercises can be practiced f or 10 to 15
seconds at a time and f or 15 to 20 times a day. They
can be done anywhere, at the workplace, while travel-
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ing, reading or watching TV [18].
2. The total duration of yoga practice
It was observed that the total duration of 3 months
with a daily practice of 1 hour was effective for signif i-
cant improvement in intravaginal ejaculatory latencies
[18], increase in mean intravaginal ejaculation time
[31] and increased duration of the sexual act [49]. One
study reported the inef fectiveness of yoga practices
in providing relief in PE and the probable reason was
thought to be shorter duration (21 days) of treatment
[1 4 ].
However, it must be understood that the scope of
yoga is not just limited to the management of PE for a
few months, but it is a way of lif e, a yogic lifestyle to
be adopted for a lifelong practice.
INDICATIONS OF YOGA FOR
PREMATURE EJACULATION
Although many treatment options are available for
PE, patients’ satisfaction and drug side effects are
always a concern. Non-pharmacological treatment
options like yoga are being explored in sexual fulfill-
ment and pleasure. The efficacy of these approaches
has been established in empirical studies [14] and they
seem pref erable [18]. Yoga also has the potential to be
used as an adjuvant to standard medical care i .e., alon g
with selective serotonin reuptake inhibitors in patients
w i th P E [5 0].
Despite the mental distress, anxiety, embarrassment,
and depression; most men with PE do not seek help [23].
The probable reason for this could be due to the stigma
and shame associated with sexual dysfunction and lack
of awareness about the availability of medical treat-
ment options [18]. Van Lankveld [51] suggested the po-
tential importance of ‘self-help therapies’ for men who
cannot visit a therapist but are motivated to adhere
to the advice and prescription. Self-treatment may be
recommended only to those cases who are refractory to
all medical treatment options or cannot afford medical
care [50]. This could benefit lots of patients who other-
wise remain untreated. But it is advisable that patients
should consult medical practitioners before trying yoga
on their own [50].
Yoga is low cost, easily available alternative which
can be practiced in the privacy and its proven benef its
can be beneficial for such patients. Also, the side ef-
fects of conventional medicines could be averted [47].
Many times, PE is without any physical cause and it
may be lifelong or acquired. In both these types of PE,
the recurrence rate is higher and the patients need to
take the drugs for a long period of time. This is true
in case of on demand medication like dapoxetine also.
However, patients expect drug-free healthy sexual life,
which in many cases is a distant dream. Yoga can fill
the gaps between patient expectations and reality.
LIMITATIONS OF YOGA FOR
PREMATURE EJACULATION
Results depend on the patients’ participation and
compliance. The patients need to spend one hour daily
to get the desired effect. This requires a high level of
motivation of the patient.
In the presence of associated co-morbid conditions,
the practice has to be modified according to individual
health, endurance, and physical capacity. In these
cases, there are limitations and contra-indications to
certain yoga practices which may aff ect the treatment
outcome. For example, in patients with hypertension or
cardiovascular disease, yoga poses, such as inversions,
Kapalbhati kriya, and Bhastrika pranayama are con-
traindicated [40]. Inverted poses like Sarvangasan may
lead to the risk of retinal detachment or bleeding and
should be avoided or practiced with utmost care only
after ophthalmic evaluation in patients with diabetes
[52]. In patients with obesity, older individuals, or those
who are unable to perform the dif ficult yoga postures,
modifications depending on their f easibility and ac-
ceptability are recommended [33].
If performed under the guidance of a qualified yoga
professional, yoga is a safe practice for all age groups.
However, to limit injuries and harm, the patients
should not exert themselves or push beyond capacity to
get into the ideal pose. Balancing poses should be prac-
ticed carefully to avoid traumatic injuries. The yoga
poses must be practiced slowly, without any sudden
jerky movements.
LIMITATIONS OF SCIENTIFIC
EVIDENCE
The review of the literature shows that the scien-
tific evidence is sparse with limited empirical studies
regarding yoga and its effect on PE. There is a vast
Anjali Mangesh Joshi, et al: Yoga in Premature Ejaculation
9
www.wjmh.org
amount of literature claiming the effectiveness of yoga
in the treatment of PE, but unfortunately there is
limited scientif ic evidence to support these impressive
claims. Although the role of yoga in sexual function is
time tested, cost-eff ective, safe, and appears promising,
there is a need for more directed extensive research
in this area. Effect of particular yoga posture or yoga
technique for PE is investigated in very f ew studies.
SUMMARY AND SPECIFIC
CONCLUSIONS FOR ROLE OF YOGA
IN PREMATURE EJACULATION
So far, limited evidence for advocating yoga in PE is
available in the scientific literature. However, promis-
ing results such as significant improvement in intra-
vaginal ejaculatory latency period, increase in mean
intravaginal ejaculation time and increased duration
of the sexual act which are attributed to yoga practices
have been reported in a f ew empirical studies.
Yoga as a time tested, safe and cost-eff ective ‘self-help
therapy’ may be recommended in those cases who are
refractory to all medical treatment options, who cannot
afford medical care or who cannot visit a therapist but
are motivated to adhere to the advice and prescription.
What yoga as therapy can offer is focus on the
mind–body connection which is lacking in the contem-
porary approaches in sex therapy. Yoga practice helps
to enrich the sexual life which can be elevated from
sensual to a spiritual plane. Yoga can be a good thera-
peutic alternative in the treatment of PE and can be
integrated in contemporary sex therapies and sexual
medicine. Integrating yoga as a non-pharmacological
treatment modality into contemporary sex therapy has
the potential to of fer benef icial ef fects f or different
facets of human sexuality.
Conflicts of Interest
The authors have nothing to disclose.
Author Contribution
Conceptualization: AMJ, RAV. Data curation: all authors.
Supervision: RAV, SD. Writing–original draf t: all authors. Writ-
ing–review & editing: all authors.
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